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NPI Code Detail

MEDICARE: DR. BRIAN MCCLELLAN

MEDICARE: DR. BRIAN MCCLELLAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist26021128AIN

General Provider Information

NPI Number : 1174806244
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN MCCLELLAN
Provider Business Mailing Address
First Line : 11743 NEWGATE CT
Second Line :
City : EVANSVILLE
State : IN
Zip : 47725-8097
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 925 S GREEN RIVER RD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-4107
Country : US
Telephone Number : 812-474-0055
Fax Number : 812-474-0982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2011
Last Update Date : 09/24/2011

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Directions to “ DR. BRIAN MCCLELLAN ” Practice Location

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